Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Otizm Spektrum Bozukluğu Olan Bireylerde Azalmış Ses Toleransı İçin Ses Zenginleştirme Terapisi: Pilot Çalışma
Sound Enrichment Therapy for Decreased Sound Tolerance in Individuals with Autism Spectrum Disorder: Pilot Study
Emre GÜRSESa, Şebnem GÜMÜŞCÜ TUŞb, Songül AKSOYa
aHacettepe Üniversitesi Sağlık Bilimleri Fakültesi, Odyoloji ABD, Ankara, TÜRKİYE
bKıbrıs Sağlık ve Toplum Bilimleri Üniversitesi, Çocuk Gelişimi Bölümü, Güzelyurt, KKTC
Turkiye Klinikleri J Health Sci. 2020;5(1):91-8
doi: 10.5336/healthsci.2019-66601
Article Language: TR
Full Text
ÖZET
 Amaç: Bu çalışmanın amacı, tinnitus, mizofoni ve hiperakuzi yönetiminde kullanılan Ses Zenginleştirme Terapisi (SZT)'nin, azalmış ses toleransına sahip Otizm Spektrum Bozukluğu (OSB) olan bireylerde etkinliğinin araştırılmasıdır. Gereç ve Yöntemler: Çalışmaya, yaşları 8-28 yıl (X=13,25 yıl, SS=±8,48 yıl) arasında değişen ve normal işitmeye sahip 6 (4 E-2 K) OSB'li birey dâhil edilmiştir. Ailelere terapi programı hakkında bilgiler verilerek, ailelerden ve/veya bireylerden aşırı hassas olunan sesleri belirlemeleri ve rahatsızlık şiddetlerini terapi öncesi vizüel analog skala (VAS)'ya işaretlemeleri istenmiştir. SZT, enstrümental müzik ve doğa sesleri kullanılarak uygun görülen MP3 veya bilgisayar uygulamaları ile sunulmuştur. SZT, üç aşamalı ve her aşama bir hafta sürecek şekilde programlanmıştır. Bireyde duyarlılık (ses tolerans artışı) sağlanana kadar terapiye devam edilmiş ve sonuçlar, terapi öncesi, 6 ve 12. haftalar olacak şekilde VAS ve bireysel görüşme yapılarak değerlendirilmiştir. Bulgular: En çok rahatsızlık hissi veren sesler; elektrik süpürgesi, çocuk ağlaması, kalabalık uğultusu, araç-egzoz sesi ve mikrofonik sesler olarak belirtilmiştir. Bazı aileler, bu sesleri duyduğunda çocuklarının hırçın davranışlar sergilediklerini açıklamışlardır. Bireylerin VAS puanları anlamlı şekilde rahatsızlığın azaldığı yönünde bulunmuştur (p<0,01). Bir aile, dayanılmaz rahatsızlık olarak belirttiği seslerin tamamen kaybolduğunu VAS puanları ile belirtmiş ve çocuğunun hırçın davranışlar sergilemediğini açıklamıştır. Sonuç: Amerikan Nöroloji Akademisi ve Çocuk Nörolojisi Topluluğu'nun komisyon raporunda, OSB'li bireylerin atipik işitsel karakteristiklerine ışık tutacak çalışmaların yapılması gerekliliği belirtilmiştir. Çalışmamız, bireylerde ses toleransının gelişebildiğini göstermiştir. Ses intoleransı olan OSB'li bireylere SZT'nin uygulanmasının etkili bir yöntem olduğu belirlenmiştir. Yapılan bu pilot çalışma sonucunda, ses intoleransı olan OSB'li bireylerde SZT'nin, karşılaştırmalı terapi teknikleri ile geniş vaka gruplarında çalışmaya değer olduğu sonucuna varılmıştır.

Anahtar Kelimeler: Otizm spektrum bozukluğu; azalmış ses toleransı; hipersensitivite
ABSTRACT
 Objective: The aim of our study is to evaluate the effectiveness of Sound Enrichment Therapy (SET) used for management of misophonia, tinnitus and hyperacusis in individuals with Autism Spectrum Disorders (ASD) with decreased sound tolerance. Material and Methods: Six individuals (4 M-2 F) with ASD with normal hearing, age ranjed between 8 to 28 (X=13.25, SD±8.48 years) were included in the study. Parents were informed about therapy program and asked from parents or individuals to identify hypersensitive sounds and mark the severity of discomfort according to visual analogue scale (VAS) at the assessment meeting. SET stimulus were composed of instrumental music and natural sounds, presented via MP3 and computer. SET is programmed in three levels, each level lasting a week. Assessement were done before the therapy, 6th and 12th weeks according to VAS and parents meeting. Results: The most disturbing sounds; vacuum cleaner, child crying, crowded humming, car-exhaust noise and microfonic sounds. Some of the parents reported that their children behaved very aggressively against these sounds. VAS scores were significantly reduced (p<0.01). One parent stated that sound tolerance were completely improved and the child didn't exhibit aggressive behavior at all. Conclusion: In the commission report of the American Academy of Neurology and Pediatric Neurology, it is stated that studies should be carried out to shed light on the atypical auditory characteristics of ASD. Our study showed that sound tolerance could be improved. Further studies, comparing between different theraphy methods and sound enrichment theraphy with larger sample group are suggested.

Keywords: Autism spectrum disorders; decreased sound tolerance; hypersensitivity
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